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Montreal Gazette
16-07-2025
- Health
- Montreal Gazette
More than 900,000 Quebecers on wait lists for consultations with medical specialists
By Aaron Derfel Nearly two out of three Quebecers in need of a consultation with a medical specialist are waiting past medically acceptable delays — up from 41 per cent at the end of 2023, Health Ministry statistics reveal. In total, nearly 910,000 Quebecers were waiting for a consultation with a specialist as of May 31, the latest date for which such figures are available. That compares with almost 832,000 people who were waiting for a consultation on Dec. 31, 2023. The figures are the latest indication of persistent access problems in the health network more than half a year into the mandate of Santé Québec, the Crown corporation that was set up to run the public system more efficiently. 'It's going form bad to worse,' veteran patient-rights advocate Paul Brunet, executive director of the Conseil pour la protection des malades, told The Gazette. 'It means that some of these patients are likely to end up in the emergency room when their health situation become more aggravated. For some, that's the only way they will be operated on or taken care of by specialists. Meanwhile, the crisis in emergency rooms is still going on. 'The state of health care is degrading,' Brunet added. Health Minister Christian Dubé has focused much of his attention on improving access to family physicians. On that score, there has been some progress, although there are still almost 644,000 Quebecers waiting for a consultation in primary care using the online portal known as the Guichet d'accès à la première ligne (for those who don't have a family doctor) — up from more than 619,000 at the end of 2024. Yet the latest numbers suggest that access to medical specialists may pose an even worse problem. What's more, the Gazette reported last month that some heart patients who have been examined by a specialist are dying on wait lists as Santé Québec and the health ministry squabble over jurisdiction and resources. A record three dozen cardiac patients have died from sudden death while waiting for a life-saving operation since the start of the year. The lengthening of wait times to see a medical specialist is coinciding with an exodus of some specialists from the public system to the private-for-profit sector. For example, more than 108,000 Quebecers were waiting for a consultation with a dermatologist as of May 31. Meanwhile, since last July the number of dermatologists who have opted completely out of the public system has climbed to 49 from 41 . The private-sector dermatologists now represent about one quarter of such specialists practicing in the province. They are charging patients out of pocket an average of $250 per consultation. Another striking example concerns orthopedics, with nearly 60,000 Quebecers waiting (often in pain) for a consultation with a specialist. At present, there are 38 orthopedic surgeons who have opted out of medicare, with about 340 remaining in the public system. Quebec has since adopted legislation to prevent orthopedic surgeons from opting in and out of medicare regularly. But the new regulations are unlikely to have an impact on those who have quit the public system permanently. Audrey Noiseux, Dubé's press attaché, referred The Gazette's queries to Santé Québec. Marianne Paquette, a spokesperson for Santé Québec, said that improving access to specialists remains a priority for the Crown corporation that was established on Dec. 1 last year. 'Although the issues surrounding access to specialists are complex, concrete (solutions) are being actively implemented,' Paquette said in an email. 'These efforts are based on reinforced clinical coordination, process optimization and concerted mobilization of all network players. The common objective remains to improve access to specialized services, with a view to ensuring equity, efficiency and responsiveness to patients' needs, throughout Quebec.'
Montreal Gazette
17-06-2025
- Health
- Montreal Gazette
Santé Québec, Health Ministry squabble as heart patients die on wait lists
By Aaron Derfel A record three dozen Quebecers have perished from sudden death since the start of the year while waiting for their heart operations, even as the Health Ministry and Santé Québec squabble over jurisdiction and resources, The Gazette can reveal. Despite repeated warnings since last year from the leaders of the provincial associations of cardiologists and cardio-thoracic surgeons about abnormally long wait times for heart operations, no new targeted actions have been taken to address the crisis by either the ministry or Santé Québec. 'We've heard nothing from Santé Québec,' Dr. Bernard Cantin, president of the Association des cardiologues du Québec, said in an interview, alluding to the Crown corporation that was set up on Dec. 1, 2024 to run the province's $65-billion-a-year public health system. 'We've received no news whatsoever.' In April, the association did hold discussions with a representative from Santé Québec, who was 'very open' but who pointed out that 'it's a fight between the ministry and Santé Québec,' Cantin recalled. 'He said it's a very difficult relationship between them. But we're now stuck in the middle of that.' Dr. Louis Perrault, president of the Association des chirurgiens cardio-vasculaires et thoraciques du Québec, agreed that bureaucratic infighting between the health ministry and Santé Québec have made matters worse for heart patients. 'Sadly, the Ministry of Health has stalled the whole thing,' Perrault said. 'We had made recommendations to fix the problem that were supposed to be put in place last June. But by last September, nothing happened. That's when the ministry started talking about, ' Oh, Santé Québec is taking over. So we're not doing anything.'' 'Last December, we wrote a letter of introduction requesting a meeting with (Santé Québec CEO Geneviève) Biron, and it took four months before they answered,' Perrault added. 'We obviously were following up every month. It was complete silence. And then finally in April we got someone on the phone from Santé Québec who is in charge of all of physical health, but it's a mammoth job and he's got no staff. So we had trouble getting answers and nothing is being done.' 'Things are getting worse because they're not organized,' Perrault added of Santé Québec. 'They're understaffed. They're overwhelmed and they don't know what to do, and they have to contend with making $1.5 billion in cuts. So we've seen it in the hospital. The cardiologists don't have access to the same technology. The bean counters tell them they can't do more volume, you have to decrease your volume or you can't have that brand new catheter that performs better.' Marianne Paquette, a spokesperson for Santé Québec, declined to comment about the concerns raised by the two doctors' associations, referring The Gazette instead to the Health Ministry. Meanwhile, an official with the ministry suggested the physicians' dire warnings may be motivated, in part, by their negotiations with the government over remuneration and working conditions. However, The Gazette has verified through the government's own statistics that the problem of lengthy wait times for cardiac patients has grown markedly worse since 2019 — years before the latest round of negotiations. For example, a dozen patients died while waiting for their heart operation during a six-month period in 2019, when cardiac surgeons first sounded the alarm about the problem. That compares with 37 sudden cardiac deaths for the most recent six-month period. What's more, the number of heart patients waiting beyond the medically acceptable delay of 90 days for surgery has increased steadily. On March 31, 2024, the rate was 53.2 per cent. That compares with nearly 62 per cent for the corresponding date this year, for a total of 774 cardiac patients who are now at heightened risk of sudden death. In addition, the number of patients on the wait list for electrophysiology — in order to install a pacemaker for the heart — has surged from about 3,000 three years ago to nearly 5,000 today, with 85 per cent waiting past medically acceptable delays. 'It's a scandal,' Perrault said. 'We're a G7 nation. People are dying on wait lists. This should not be happening.' As Cantin explained: 'In cardiology, we're fighting against sudden death. So depending on the intervention that's needed, it's safe to do it within two months. We know we may lose some people on the wait lists but that impact should be minimal. What's happening now, though, is that with almost two-thirds of patients not getting operated within the allotted time, you just increase the risk of sudden death. And now that's what we're seeing.' The administrative tug-of-war between the Health Ministry and Santé Québec would appear to validate the objections that critics have made about the new organization creating an unnecessary parallel bureaucracy that would only slow down the delivery of medical care. Health Minister Christian Dubé created Santé Québec with the goal of streamlining bureaucracy, entrusting the Crown corporation with negotiating with the unions and running the network on a daily basis, leaving the ministry in charge of so-called strategic planning. Both Cantin and Perrault attributed the lengthy delays for heart surgery to a severe shortage of perfusionists, the technicians who run the heart-and-lung machines. At present, there are 70 for the whole province, and they said Quebec needs 90 for the system to function smoothly. 'I'm director of the perfusionist program at the Université de Montréal and our graduates are leaving for Ontario, for Alberta, for the United States,' Perrault noted. 'Our perfusionists are the lowest-paid in Canada. A lot of people are quitting the profession, taking an early retirement because when the teams are incomplete the work becomes so hard. So much of their work is on call. People don't like the lifestyle.' As a consequence, when a perfusionist is not available, a heart surgeon is left with no choice but to postpone an operation at additional cost to the system. Marie-Claude Lacasse, coordinator of media relations at the Health Ministry, confirmed the government is 'concerned about reports of deaths directly associated with the lack of perfusionists.' 'The (Health Ministry) is aware that the needs are great and that solutions must be found,' Lacasse said in an email. At the same time, however, she disputed that the root problem may be a shortage of perfusionists. 'According to the data ... the unavailability of a perfusionist is the reason given in less than 1 per cent of surgical cancellations,' she added. 'We invite the unions to send us this data so that the appropriate follow-up can be done properly and quickly. Discussions are still underway with the unions representing perfusionists, notably involving the Treasury Board.' Audrey Noiseux, Dubé's press attaché, also appeared to downplay the concerns by the doctors' groups, suggesting this may be a bargaining tactic. 'The information reported is worrying,' she said, adding that 'one thing is clear: we, too, are very concerned about surgical waiting lists.' Still, Noiseux emphasized that 'we are negotiating with the federation of medical specialists, and that discussions are currently underway with the perfusionists' union, so we will remain cautious in our comments. That said, we cannot continue to give more money for the same results. With Santé Québec, we will continue to do everything we can to reduce waiting lists, and everyone has a role to play.'
